Year: 2026
Type: article
Abstract: With several maternal health conditions identified as associated with increased autism spectrum disorder (ASD) in offspring, determining the reasons underlying these associations and identifying populations most impacted has garnered interest.In the study by Messaoud et al 1 investigating how previously observed associations may differ by race and ethnicity, results suggested that although maternal health conditions were consistently associated in most race and ethnicity groups, associations for maternal body mass index, depressive symptoms, asthma, and pregnancy complications were more prominent in mothers who identified as White. 1 Ascertainment of both maternal health conditions and offspring ASD diagnosis for this study were assessed via the wealth of data available in Kaiser Permanente Northern California (KPNC) health system records. 1 As advantageous as electronic health records have proven to be for largescale observational studies, these metrics still require health care access.One of the reasons the authors cited for conducting this study was potential differences in prenatal health care access by race and ethnicity.Specifically, disparities in both access and quality of health care have been well documented as disproportionally affecting Black and Hispanic mothers.Studies have also shown disparities in ASD diagnosis by maternal race, with a recent study using data from the Environmental Influences on Child Health Outcomes cohort finding that even when children had a Social Responsiveness Scale score indicative of ASD, non-Hispanic Black children were less likely to have a clinical diagnosis of ASD. 2 However, accounting for moderation by race and ethnicity of mothers may not capture disparities in ASD diagnosis for children.Maternal race and ethnicity ignores that of the father, which may be different from the mother, and the social construct of race can be classified differently for children in multiracial or multiethnic families.Studies have shown that irrespective of maternal race and ethnicity, there are differences in health care access based on the child's race.3 Although this would not influence the maternal conditions assessed in this study, differing assignments in race can impact child health outcomes, including ASD diagnosis, and using the mother's race and ethnicity can lead to underestimation of inequities.3 Although there have been improvements in ASD identification and diagnosis, 4 until recently, reported autism diagnosis and prevalence in the US was consistently lower for Black, Hispanic, and Asian or Pacific Islander children for several years.4 The US Centers for Disease Control and Prevention (CDC) has made strides in closing the race and ethnicity gap in autism prevalence reports by mitigating barriers to diagnostic services through autism awareness efforts and encouragement of early screening.4 However, these same data show that Black children are more likely to have a co-occurring intellectual disability diagnosis, suggesting children with greater symptom severity are more likely to be identified, and diagnostic disparities for autism persist.It is also important to note that of the 11 sites the CDC currently has for autism surveillance, California has the highest reported prevalence and earliest mean age for first-recorded evaluation and diagnosis.4 Data from the California Developmental Services suggests similar narrowing of racial and ethnic diagnostic gaps for children of Black and Asian mothers, 5 which again rests on the belief that the social construct of race is equally experienced for mothers vs children.However, overall patterns in clinical diagnosis of ASD and other developmental disorders suggest that race and ethnicity disparities in autism diagnosis in California are less prominent than the rest of the US, although they still exist, 5 and racial and ethnic +
Source: JAMA Network Open
Author: Aisha S. Dickerson
Institution: Johns Hopkins University
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7220416547